Implants Double Infection Risk After Breast Reconstruction

TUESDAY, Jan. 22 -- Breast cancer patients who undergo reconstruction surgeries after a mastectomy are twice as likely to suffer an infection at the surgery site if they receive an implant instead of their own tissue, a new study finds.

Researchers at the Washington University School of Medicine in St. Louis analyzed 949 hospital admissions for mastectomy or breast reconstruction surgery at a university-affiliated hospital between 1999 and 2002.

Reporting in the January issue of the Archives of Surgery, they found that surgical site infections occurred in 50 women (5.3 percent) within one year of surgery. These infections arose in a little more than 12 percent of mastectomies where breast reconstruction involved an implant, compared to just over 6 percent of mastectomies where the reconstruction involved the patient's own abdominal tissue.

"The bottom line is that implants are associated with an increased risk of infection in breast cancer patients," study author Margaret Olsen, a research assistant professor of medicine at the university, told The New York Times. "The question is what factors contribute to this increased risk and what can be done to prevent it?"

The average time between surgery and infection diagnosis was about 47 days, the researchers noted.

Patients with surgical site infections had significantly higher hospital cost -- an average of about $4,100 per patient -- and they had a significantly longer total length of hospital stay, the study authors wrote.

Speaking to the Times, another expert said there are many reasons why implants could boost infection risks. Dr. Stephen R. Colen, chairman of plastic and reconstructive surgery at Hackensack University Medical Center in New Jersey, said that any time a foreign body is introduced during surgery it provides a surface on which bacteria can grow. And implantation involves a number of procedures that create opportunities for infections to occur, he said.

But Colen also stressed that reconstruction using abdominal tissue has its own risks. He told the Times that these procedures take several hours longer than implant reconstructions, boosting patients' odds for blood clots and lung embolisms. And in 2 percent of cases, the transplanted tissue dies, necessitating more surgeries.

Effective prevention measures would reduce both infections and related costs, Olsen's team wrote. Those measures include, "strategies to optimize the timing and dosage of prophylactic antibiotics administered before the surgical incision, glucose control in diabetic patients, promotion of meticulous hand hygiene and strategies to promote timely removal of drains, among others," they said.